Payment News

Posted on Feb 6, 2020 by Chapter Staff
Originally Published in APTA Hawaii’s Monthly e-Newsletter – February 2020

CMS Reverses Same-Day Coding Methodology Changes Implemented on January 1

If you haven’t heard yet – on January 24, the Centers for Medicare and Medicaid (CMS) announced it was reversing its decision to disallow payment for some treatments provided on the same day as an evaluation. And yesterday, they announced that they’ve instructed their Medicare Administrative Contractors (MACs) to make claim adjustments.

Besides extensive lobbying from APTA, an outpouring of comments from members helped achieve this reversal.

Humana Adopts Medicare’s PTA Coding System That Took Effect January 1

Commercial payer Humana announced last month that it will adopt the PTA 85 percent payment differential coding system adopted by CMS, which took effect on January 1, 2020. While payments by Humana and Medicare won’t decrease until 2022, both payers now require reporting of related PTA treatment to include the CQ modifier. Use this Quick Guide to Using the PTA Modifier developed by APTA to determine when you need to use the modifier.

Medicare Thresholds That Require KX Modifier

Although the therapy cap is a thing of the past, providers still need to attest that treatment paid for by Medicare is medically necessary by using a KX modifier when the total cost reaches a certain amount. Find the thresholds and process for treatment provided in 2020 on the APTA website.

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